Reducing variations in care

Reducing variations in care for patients with Diabetes across Newham

Newham, East London, faces some significant challenges in improving the healthcare of its 250,000 residents. It has one of the most ethnically diverse populations in the country and is the eleventh most deprived area in England.

The aim was to use a local care pathway as a means of improving the delivery of diabetes care and to reduce the variation in the delivery of care for patients. Newham wanted to manage all appropriate patients in primary care, reduce unnecessary referrals to secondary care, and ensure patients who need to be referred to secondary care were referred at the most appropriate time, without delay.

The role of the Map of Medicine

As part of the North East London Collaborative Commissioning Group, Newham is using the Map of Medicine to enhance the quality of care for all patients, implement national and local targets and better measure their success. The Map was chosen as it had a range of best clinical practice and evidence based pathways and offered the flexibility to be localised.

Milestones

• Newham LHC had developed care pathways for numerous conditions but their uptake was slow and benefits not realised.
• The scope of the original project was to localise the type 2 diabetes pathway, diabetes in pregnancy and diabetes in children and adolescents pathways in order to align with the Healthcare for London recommendations.
• A series of workshops were held to redesign the diabetes pathways, which included secondary care consultants, GPs, allied health professionals, commissioners and patient.
• The pathway was clinically localised and published, incorporating local administration information and promoted through launch events, presentations and practice visits.
• Newham LHC is moving towards incorporating pathway development work into business as usual and further local pathways will be prioritised as an integral part of the Strategic Planning stage in the World Class Commissioning process.

Challenges

• Successfully engaging IT, clinical teams and the acute trust. Launch events and group presentations in both primary and secondary care were not well attended.
• This was resolved through individual practice visits and demonstrations, presentations at Clinical Risk group meeting at the acute as well as working with champions. An important lesson learnt was to schedule workshops early, especially for secondary care clinicians and clinical leads.

Results

Pathways and the Map of Medicine have become an integral part of NHS Newham’s planning stage of the commissioning cycle leading to improved engagement, clinical collaboration and patient input. More than a third of GPs, practice nurses and other healthcare professionals are now registered to use the Map.

Since the Diabetes pathway was launched, Newham has seen a reduction of 14% in the first to follow up ratios for Newham University Hospitals Trust, despite an increase in the number of outpatient attendances to secondary care. Initial results also indicate an improvement in medicines management.

The pathway localisation process assisted in the re-commissioning of the diabetic retinal screening service.